Essential Thrombocythemia

ET, or primary thrombocythemia, is a chronic MPD characterized by a clonal proliferation of megakary-ocytes in the bone marrow. The peripheral blood platelet counts exceed 600,000 pL and can be greater than 1 million. This disease is characterized by an Table 12.11 O Key Facts for Essential Thrombocythemia Marked thrombocytosis (platelet count > 600 X 109 L) Neurological manifestations Megakaryocyte fragments in both peripheral blood and bone marrow Absent Philadelphia chromosome increased...

Unopette White Blood Cellplatelet Count

The Unopette system is a system of prefilled blood dilution vials containing solutions that will preserve certain cell types while lysing others. Capillary pipettes are available to draw up different volumes of blood. The dilution is determined by the type of capillary used. The diluted blood is added to a hematocytometer chamber, Table 20.4 O Qualitative Grading of RBC Morphology 6 to 15 cells 10 fields Moderate Table 20.5 O Red Cell Morphologies Matched to Clinical Conditions RBC Morphology...

The Spleen As An Indicator Organ Of Hematopoietic Health

Few organs can match the versatility of the spleen. This small but forgotten organ is a powerhouse of prominent red cell activity such as filtration, production, and cellular immunity. Under normal circumstances, the organ cannot be felt or palpated on physical examination. This fist-shaped organ, located on the left side of the body under the rib cage, weighs about 8 ounces, is soft in texture, and receives 5 of the cardiac output per minute. The spleen, a blood-filled organ, consists of red...

O Troubleshooting

What Do I Do When Red Cell Inclusions Have Been Misidentified A 36-year-old chronic alcoholic with liver disease and pneumonia was admitted to the hospital. Her admission was for treatment of the pneumonia. Routine CBCs including differential were ordered daily to monitor her white count during the treatment process. During evaluation of her peripheral smear, a shift to the left was observed. This is a term used to describe the presence of younger white cells from the bone marrow in response to...

Flow Cytometry The Basics In Hematology Interpretation

The information presented here is purposefully simplistic. An elaborate explanation of flow cytometry is not appropriate for the audience and tone of this text. Flow cytometry is a specialty technique and a recent Google search listed 10 pages of entries referring to certificate programs for this specialty. For additional information, the student is referred to LMtt& ii S flMnOmJIlmp 1V06 7U Ot3 'j4 j I iJtWtllllllflT F Qn Alii U3F ONl V uk 10.5 loniai. Table 20.15 O Applications of Flow...

Iron Intake And Iron Absorption

Iron is one of the most abundant metals in the world, yet IDA continues to be one the most prominent nutritional disorders worldwide.1 Many factors contribute to this situation and they need to be understood to have a fuller appreciation of iron balance. Iron balance is regulated by several conditions (a) the amount of iron ingested, (b) the amount of iron absorbed, (c) red blood cell formation using recycled and new iron, (d) iron stores, and (e) iron loss through blood loss or other sources...

The Role Of Fibrinogen In Hemostasis

Fibrinogen is the principal substrate of the coagulation and fibrinolytic system. This clotting factor has the highest molecular weight of all of the clotting factors, and it is the substrate upon which the coagulation system is centered. This factor is heat labile but stable in storage. When fibrinogen is transformed to fibrin under the influence of thrombin, it is the onset of solid clot formation. The formation of fibrin occurs within minutes due in part to a positive feedback mechanism...

Standard Precautions

The clinical laboratory presents an environment with many potential risks from biological hazards to chemical or fire hazards. Safety training has become a mandatory part of responsible employee practice, not only for employees themselves but also for their colleagues. Safety training sessions are an essential part of employee training. These sessions represent a lifeline toward optimal behavior should an employee encounter an unexpected hazard. Biological hazards constitute one of the more...

Vascular Disorders Leading To Platelet Dysfunction

Skin, collagen, and blood vessels are essential elements in the hemostatic system. Any abnormality, inherited or acquired, in any one of these components of the vascular system will lead to mucosal bleeding such as purpura, petechia, ecchymoses, or telangiectasia (Fig. 16.3). Tests of platelet function and numbers in these individuals will be normal. Senile purpura is a condition of aging in which skin loses its elasticity. Oftentimes, older individuals will bruise more easily and more...

Laboratory Diagnosis For Thrombotic Disorders

The availability of a wide range of assays to evaluate the hypercoagulable state has enhanced the diagnosis of inherited and acquired thrombotic events. However, the assays are expensive and time consuming. These laboratory tests should be considered for patients in whom the test results will impact the choice, intensity, and duration of anticoagulant therapy, family planning, and prognosis.1 The clinical events that justify laboratory evaluation of hypercoagulable states are listed in Table...

Pathogenesis Of Thrombosis

Hemostatic changes that are important in the pathogen-esis of thrombosis are vascular injury due to the toxic effect of chemotherapy platelet abnormalities (more important in arterial thrombosis) coagulation abnormalities, fibrinolytic defects, and deficiencies of the antithrombotic factors. Vascular injuries play an important role in arterial thrombosis. Vascular injury initiates platelet adhesion to exposed subendothelium. The adherent platelets release the contents of alpha and dense...

Introduction To The White Cell Disorders

Because white cells have such a short time span in the peripheral circulation, alterations either in the quantity of or the quality of a particular cell can be quite dramatic. With the normal differential reference ranges for adults and children as a benchmark, any increase or decrease in a particular type of cell signals the body's unique response to assaults of any kind. Infection, inflammation, chronic disease, parasitic infestations, etc., each represents an unexpected occurrence, an...

Clinical Features Of Patients With Megaloblastic Anemia

Megaloblastic anemia is usually a disease of middle-aged to older age with a high predilection for women. Severe anemia, in which the hemoglobin drops to 7 to 8 g dL, is accompanied by symptoms of anemias such as shortness of breath, light-headedness, extreme weakness, and pallor. Patients may experience glossitis (sore or enlarged tongue), dyspepsia, or diarrhea. Evidence of neurological involvement may be seen with patients experiencing numbness, vibratory loss (paresthesias), difficulties in...

Info

Specimen should be well mixed and left on a rocker for at least 5 minutes before using. Check Unopettes for clarity and contents. If the Unopette chambers appear cloudy or the amount of reagent looks questionable, do not use. With the reservoir on a flat surface, puncture the diaphragm of the reservoir using the protective shield of the capillary pipette. a. Using a twist action, remove protective shield from the pipette assembly b. Holding the pipette and the tube of blood almost horizontally,...

Microhematocrit

The hematocrit or packed cell volume measures the concentration of red blood cells (RBCs) in a given volume of whole blood in a capillary tube. This volume is measured after appropriate centrifugation time and is expressed as a percentage of the total blood sample volume. A whole blood sample in an anticoagulated tube is An Approach to Interpreting Automated Hematology Data Flow Cytometry The Basics in Hematology Interpretation Data Interpretation One Role for the Medical Technologist...

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Figure 5.10 Erythroid hyperplasia the bone marrow's response to anemic stress. Figure 5.11 Thalassemia major, showing a high degree of poikilocytosis and nRBCs. Figure 5.11 Thalassemia major, showing a high degree of poikilocytosis and nRBCs. inheritance for this disorder was described by Dr. W N. Valentine in 1944, and since 1960, the genetic interactions and the cloning of the thalassemic genes have been accomplished. Yet there has been no cure. The Pathophysiology of the Thalassemias Unlike...

Lori Lentowski and Betty Ciesla

Modified Westergren Sedimentation Rate Reagents and Equipment Specimen Collection and Storage Quality Control Procedure Normal Values Conditions Associated With. Limitations Reticulocyte Procedure With Miller Eye Disc Reagents and Equipment Specimen Collection and Storage Quality Control Conditions Associated With. Limitations Performing a Manual Differential and Assessing Red Blood Cell Morphology Reagents and Equipment Specimen Collection and Storage Quality Control Procedure Unopette White...

Acute Lymphoblastic Leukemia

Acute lymphoblastic leukemia (ALL) is a malignant disease that evolves as a result of mutation of lymphoid precursor cells that have their origin in the marrow or thymus, at a particular stage of maturation. The immunophenotype reflects the antigen expression of the stage of differentiation of the dominant clone. The leukemic cells persistently accumulate in intrame- dullary and extramedullary sites, constantly competing with normal hematopoietic cell production and function. This results in...

Pernicious Anemia As A Subset Of Megaloblastic Anemias

Intrinsic factor is the single most important ingredient to the absorption of vitamin B12 and subsequent delivery of vitamin B12 to the circulation. When problems with intrinsic factor develop, the condition is called pernicious anemia. Drs. George Minot and William Murphy of Boston were awarded the Nobel Prize in 1934 for their discovery that ingestion of liver successfully treated patients with pernicious anemia. Several factors may account for the lack of intrinsic factor in the stomach,...

Condensed Case

A 7-year-old child had a fall from a piece of playground equipment. After 24 hours, he developed a deep hematoma in his right thigh and his parents brought him to the emergency department to be evaluated. His family history did not give any indication of any previous bleeding from birth or otherwise. What tests should be ordered to rule out a coagulation defect Although his family history does not indicate a clotting factor abnormality, preliminary clotting tests should include a bleeding time,...

Case Study

Eight-year-old twin boys were brought into the emergency department with complaints of intermittent fevers and lethargy. The boys had not been feeling well for the last 2 weeks. They had recently returned from a trip to Nigeria with their parents. All members of the family had been treated with antimalarial medication before the trip. Neither parent exhibited any of the symptoms of the children. A CBC with differential was ordered as well as a peripheral smear for malarial parasites. The...

Lymphocyte Origin And Function

The lymphocytic series is distinctive in its presentation and function. In contrast to most other white cells, which are derived solely from the bone marrow, lymphocytes are derived from two locations. The primary lymphoid organs are the bone marrow and thymus. The secondary lymphoid organs are the spleen, lymph nodes, Peyer's patches of the gastrointestinal tract, and the tonsils. Additionally, the lymphatic system plays an essential role in lymphocyte development, differentia- Figure 9.11...

Ineffective Erythropoiesis In Megaloblastic Anemia

The bone marrow is hypercellular in the megaloblastic conditions and the white cell precursor cells are large, especially the metamyelocytes. The myeloid-to-erythroid (M E) ratio is 1 1 or 1 3, reflecting erythroid hyperplasia as you would see in the bone marrow Figure 6.2 Normoblastic erythropoiesis with a polychro-matophilic normoblast (arrow). Figure 6.2 Normoblastic erythropoiesis with a polychro-matophilic normoblast (arrow). Bone marrow destruction of erythroid precursors Lack of...

Manual Reticulocyte Procedure

The reticulocyte count is an index of bone marrow red cell production. The reticulocyte is the cell stage immediately before the mature erythrocyte. This cell spends 2 to 3 days maturing in the bone marrow before it is released into the peripheral circulation, where it spends an additional day of maturation. The reticulocyte count is the most effective measure of erythropoietic activity. Reticulocytes contain RNA and can be observed using supravital stains such as New Methylene Blue or...

LEjCl

Note Page numbers followed by f and t indicate figures and tables, respectively. Acanthocytes, 307 Accuracy precision clarification of, 9, 10f Activated partial thromboplastin time (aPTT), 238 automated procedure for, 315-318 in hemophilia A diagnosis, 260 Activated protein C resistance (Factor V Leiden), 285 laboratory diagnosis, 285-286 pathway, 285f Acute basophilic leukemia, 175 Acute erythroid leukemia, 173-174, 173f Acute hemolytic anemia, 103-104 Acute lymphoblastic leukemia (ALL), 175...

Cerebrospinal Fluidbody Fluid Cell Count And Differential

The examination of the cellular component of body fluids is an important part of total body fluid testing. Cell counts are performed in a counting chamber. Cere-brospinal fluid (CSF), synovial fluids, and serous fluids of the pleural, pericardial, and peritoneal cavities all have characteristic cellular elements, which often change with disease in predictable patterns. Cell counts and cell morphology are key elements in identifying abnormalities within each of these systems. The methods...

Hereditary Spherocytosis

Hereditary Spherocytosis Bone Marrow

The Genetics and Pathophysiology of Hereditary Spherocytosis Hereditary spherocytosis (HS) is a well-studied disorder and fairly common among individuals of northern Figure 7.1 Spherocyte. Note the density of the cell with respect to the other red cells in the background. Figure 7.1 Spherocyte. Note the density of the cell with respect to the other red cells in the background. European origin, with an incidence of 1 5000.1 The mode of inheritance in 75 of individuals is autosomal dominant,...

Tall

*These are example of chromosome abnormalities the list is not intended to be comprehensive. Figure 11.2 Acute myeloid leukemia with t(8 21) (q22 q22). Note Auer rod in myeloblast. *These are example of chromosome abnormalities the list is not intended to be comprehensive. ence texts for an in-depth discussion of immunophe-notypes and genetics that are characteristic for each disorder. Acute Myeloid Leukemia With t(8 21)(q22 q22) This leukemia occurs most often in children or young adults and...

Glucose6phosphate Dehydrogenase Deficiency

There are a limited number of inherited disorders of red cells related to biochemical deficiencies. Glucoses-phosphate dehydrogenase (G6PD) deficiency represents a fascinating and far-reaching disorder that has at its core a metabolic misstep. G6PD is the catalyst in the first stages of the oxidative portion of the red cell's metabolism and a key player is the phosphogluconate pathway, whose role it is to keep glutathione in the reduced state. Glutathione is the chief red cell antioxidant and...

Reticulocyte Procedure With Miller Eye Disc

A Miller Eye Disc is placed inside the microscope eyepiece as an aid to counting reticulocytes. This reticule is a large square inside a small square and provides the technologist the ability to isolate the reticulocytes while counting. 1. New Methylene Blue (Supravital Stain) 4. Microscope with Miller ocular eye disc 1. One EDTA tube or EDTA Microtainer 2. Specimens can be stored at room temperature for 8 hours or refrigerated at 2 to 8 C for 24 hours. Commercially prepared controls are...

Review Questions

One of the hallmarks in the diagnosis of a patient with CML is d. an M E ratio of 10 1 or higher. 2. The BCR ABL fusion gene leads to b. increased tyrosine kinase activity. 3. Blast crisis in CML means that there are more than _blasts in the peripheral smear 4. The origin of the dry tap in MMM occurs as a result of a. extramedullary hematopoiesis. b. the presence of teardrop cells in MMM. c. the infiltration of fibrotic tissue in MMM. d. the increase of megakaryocytes in MMM. 5. Thrombotic...

Quantitative Disorders Of Platelets

A normal platelet count is 150 to 450 X 109 L. In this range, an individual will have properly functioning platelets that assist in the coagulation process by creating a platelet plug and stimulating the formation of a solid fibrin clot. A decrease in platelet count will cause bleeding from the mucous membranes such as gum bleeding (gingival bleeding), nose bleeding (epistaxis), extensive bruising (ecchymoses), or petechiae (pinpoint hemorrhages). A patient with a platelet count of 60,000 will...

Review Questions fl

Which of the following are defects of platelet adhesion 2. Which one of the conditions will produce a thrombocytopenia due to an altered distribution of platelets 3. One of the main differences between TTP and HUS is d. microangiopathic hemolytic anemia. 4. Nose bleeding, deep bruising, and gum bleeding are usually manifestations of which type of coagulation disorder 5. The presence of thrombocytopenia and giant platelets best describes a. classic von Willebrand's disease. 6. Chronic idiopathic...

Hereditary White Cell Disorders

Pseudo Pelger Huet Cells

This inherited disorder is associated with thrombocytopenia and giant platelets. Abnormal bleeding may be seen in a small number of affected individuals. Dohle bodies are seen in the cytoplasm of neutrophils and are larger than the Dohle bodies seen in neutrophils responding to infections or inflammation. Alder's Anomaly (Alder-Reilly Anomaly) This rare genetic disorder is associated with the presence of coarse dark granules in neutrophils, lymphocytes, monocytes, eosinophils, and basophils...

Dohle Bodies Vs Ehrlichiosis In Neutrophils

Toxic Granulation

Figure 10.2 The evolution of toxic granulation. Figure 10.3 Toxic granulation. Note heavier granulation throughout the cytoplasm. Figure 10.3 Toxic granulation. Note heavier granulation throughout the cytoplasm. Normal granulation in the segmented neutrophils shows a dustlike appearance, with the red and blue granules being difficult to observe. Toxic granulation is excessive granulation in amount and intensity, with more prominent granules in segmented neutrophils in direct response to...

Red Blood Cell Membrane Development And Function

The mature red blood cell is a magnificently designed instrument for hemoglobin delivery. As a hemoglobin-filled sac, the red cell travels more than 300 miles through the peripheral circulation, submitting itself to the swift waters of the circulatory system, squeezing itself through the threadlike splenic sinuses, and bathing itself in the plasma microenvironment. Cellular and environmental factors contribute to red cell survival. In order for the red cell to survive for its 120-day life...

Comparing Acute And Chronic Leukemia

The initial evaluation of leukemia is initially made by 1. Noting the onset of symptoms 2. Analyzing the complete blood count CBC results 3. Observing the type of cell that predominates cell lineage 4. Assessing the maturity of cells that predominate Because leukemia is a disease of the bone marrow that causes normal bone marrow cell production to be crowded out as the abnormal, neoplastic cells take over, the CBC results will commonly show a decreased red cell count or anemia, as well as a...

Iron Storage And Recycled Iron

Fe2 And Ferritin

Ferritin and hemosiderin are the primary storage forms of iron. These compounds are harbored in the liver, spleen, bone marrow, and skeletal muscle. Ferritin can be measured in plasma, while hemosiderin is more often identified in the urine or stained through the bone marrow. Iron stores in men are generally 1.0 to 1.4 g of body iron, and for women, 0.2 to 0.4 g. Given these figures and with the realization that the iron absorption requirement is on average 1 mg day, it is easy to understand...

Performing A Manual Differential And Assessing Red Blood Cell Morphology

When blood samples are evaluated by the use of automated hematology analyzers, this analysis includes automated differentials. Specific criteria pertaining to normal, abnormal, and critical values have been programmed into the analyzers by the institution, and if the differentials do not meet these criteria, verification is necessary. This is done by performing manual differentials and further evaluating the peripheral smear. First, a differential white blood cell WBC count is performed to...

Peripheral Smear Procedure Principle

When automated differentials do not meet specified criteria programmed into the automated hematology instrument, the technologist technician must perform a manual differential count from a prepared smear. There are two types of blood smears the wedge smear and the spun smear. The wedge smear will be discussed in this procedure. Smears are prepared by placing a drop of blood on a clean glass slide and spreading the drop using another glass slide at an angle. The slide is then stained and...

What Cd Markers Are Seen In Bone Marrow

Stages Lymphoblastic Lymphoma

178 Part III White Cell Disorders In addition to immunophenotype, certain chromosomal alterations have been identified in B-ALL that are considered prognostically important see Table 11-8 . While these abnormalities are not as consistently associated as the Philadelphia chromosome seen in CML, they do provide additional information that can help to refine the treatment regimen. Two abnormalities that have been associated with a good prognosis are 1 hyperploidy greater than 50 and 2 t 12 21 p13...

Reactive Lymphocytosis In Common Disease States

Reactive Lymphocytes Pics

It is normal for young children between the ages of 1 and 4 to have a relative lymphocytosis. The white cell differential in this age group will show a reversal in the number of lymphocytes to segmented neutrophils from the adult reference range. The lymphocytes, however, will have normal morphology Fig. 10.11 . By far the most common disease entity displaying variation in lymphocytes is infectious mononucleosis. This is viral illness caused by the Epstein-Barr virus EBV , a member of the human...

Sickle Cell Procedure Principle

The sickle screen kit provides a procedure based on differential solubility. Hemoglobin S is insoluble when combined with a buffer and a reducing agent. This occurs when the blood is mixed with the buffer and sodium hydrosulfate solution. Specimens containing hemoglobin S are insoluble and show a turbid cloudy solution. Normal adult hemoglobin A is soluble and produces a transparent solution. The presence of hemoglobin S in either the heterozygous or homozygous state will produce a cloudy...

Acute Myeloid Leukemia

AML is malignant, clonal disease that involves proliferation of blasts in bone marrow, blood, or other tissue. The blasts most often show myeloid or monocytic differentiation. Almost 80 of patients with AML will demonstrate chromosome abnormalities, usually a mutation resulting from a chromosomal translocation the transfer of one portion of the chromosome to another .9 The translocation causes abnormal oncogene or tumor suppression gene expression, and this results in unregulated cellular...

The Microscope

The microscope is an essential tool to the hematology laboratory professional. It is a piece of equipment that is stylistically simple in design, yet extraordinarily complex in its ability to magnify an image, provide visual details of that image, and make the image visible to the human eye.2 Most commonly used today are compound microscopes, which use two lens systems to magnify the image. The ocular devices on the microscope provide an initial X10 magnification, and then additional...

Hematological Features Of Megaloblastic Anemias

The CBC shows a pancytopenia low white count, low red count, and low platelet count , although the platelet count may be only borderline low see normal values on the front cover of this textbook . Pancytopenia in the CBC combined with macrocytosis should raise the index of suspicion toward a megaloblastic process because few other conditions aplastic anemia, hyper-splenism show this pattern.4 Red cell inclusions such as basophilic stippling and Howell-Jolly bodies may be observed. Howell-Jolly...

Hematology in Practice

Betty Ciesla

Faculty, Medical Technology Program Morgan State University Baltimore, Maryland Assistant Professor Villa Julie College Stevenson, Maryland F. A. DAVIS COMPANY Philadelphia F A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com Copyright 2007 by F. A. Davis Company Copyright 2007 by F A. Davis Company. All rights reserved. This product is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means,...

Bacteria And Other Unexpected White Cell Changes

The presence of bacteria in a peripheral smear indicates bacteremia or sepsis, a condition that may have severe consequence to the patient. Blood is a sterile environment such that the presence of gram-positive or -negative bacteria, fungi, etc., is an unwanted event. Bacteria may be seen intracellularly or extracellularly as either cocci or rods. In either case, bacteria must be recognized and the significant medical caretakers must be alerted Figs. 10.15 and 10.16 . Precipitated stain may at...

Differentiate Extramedullary And Intramedullary Hematopoiesis

Hematopoiesis

Anticoagulant Agent that prevents or delays blood coagulation Pathophysiology Study of how normal processes are Protocols Formal ideas, plan, or scheme concerning patient care, bench work, administration, or research 1. Wintrobe M. Milestones on the path of progress. In Wintrobe M, ed. Blood, Pure and Eloquent. New York McGraw-Hill, 1980 1-27. 2. Abramowitz M. Microscope Basic and Beyond. Vol. 1. Melville, NY Olympus America Inc, 2003 1.25. 3. Wallace MA. Care and use of the microscope. In...